Living is Dying.
Besides being the name of a wonderful book by Dzongsar Jamyang Khyentse, the statement is truth. From the moment we are born, we continue our beautiful journey toward the inevitable. Buddhists and other traditions have a strong contemplative practice around death. It is not seen as separate from life – simply a phase, a passage on the eternal journey of being.
Even though it is inevitable and there are many accounts of it actually being a deeply peaceful experience, many people are in denial or fear of dying.
Often times it is improssible to predict or plan for the final days or moments. But giving death some deep consideration can actually be a profoundly enriching experience.
When we connect with the sacredness of death, we can awaken to live life fully.
Whether in a facility or at home, whether present in mind of completely losing it, whether physically vital or bedridden – these considerations can significantly enhance someone’s experience of their final days.
It’s important to find resources – HERE is a wonderful compilation of supports in Santa Fe, NM. You can look in your hometown for similar groups, Death Lounges, and Death Doulas – all of which can make a world of difference in the final days of your loved ones and in your own life.
*If someone is terminally ill and contemplating the possibility of medically-assisted passage, it’s important to note that places where this is legal require a minimum 6-month residency and diagnosis of terminal illness for eligibility.
*Consider giving some thought to planning your own end-of-life. Regardless of your age. It’s a powerful exercise that brings tremendous insight and even peace of mind.
1. Comfort – Physical
- If someone is mobile, make sure all floor surfaces are non-slip. Install ramps where possible, and handlebars anywhere they may be walking. Make sure all canes/walkers/wheelchairs are in optimal condition and able to hold the full weight of a human body.
- For those who are mostly in bed,prevent bed sores and pneumonia by facilitating movement at least several times each day, keeping all skin dry (think baby powder), and monitoring while eating to make sure no food goes into their lungs.
- Trained body transporters and aides can show you how to best move someone without hurting them. CPR classes are a great way to quickly learn how to intervene in the event of choking.
- Create a comfortable place to lay and sit, such as a reclining chair or adjustable hospital bed with a memory foam mattress for softness.
- Make sure they can easily look out a window, bring plants and flowers into the space and line of vision – access to nature has a profoundly calming effect.
- Eliminate any harsh, overhead lighting – standing lamps and natural light is much less aggravating to the nervous system.
- Make sure there is plenty of fresh air – open a window, run an air purifier, even if they are using an oxygen machine.
- Keep favorite items in sight and in reach. Just like a child needs their favorite blanket or teddy bear, someone in their last days benefits greatly from familiar and cozy items to keep their mind and emotions calm.
- Limit sudden, loud noise and play beautiful music. Consider using a white noise machine if loud noises prevail as they can be irritating. Play music that is soothing to the mind and heart.
- Provide nurturing and loving touch, consider having an animal like a dog or cat present.
- Use video baby monitors when in another room to keep an eye on them in case they make sounds of distress or movements that indicate a need.
- Gentle massage, acupuncture, cranio-sacral therapy and chiropractic care are all wonderful supports for the physical body at the end of life.
2. Comfort – Mental
- All of the above provisions support mental comfort.
- If someone is agitated, confused, suffering from delirium, fright or psychosis, medications such as hesperidol and dilaudid are available to treat acute symptoms. Chinese herbal formulas such as An Shen Ding Zhi Wan can treat delirium and fright, and Suan Zoo Ren Tang can greatly help in cases of weepiness and restless sleep.
- Consider a death doula for the patient, and a grief counselor for any caregivers. End-of-life conversations can be difficult, and often there is confusion and difficulty accepting what is happening. Counseling from properly trained professionals can bring tremendous relief, and prevent caregiver burnout.
- Consider Somatic Experiencing or Shame Healing therapy as transitional times can be traumatic and inherently shaming. There is no better time to enlist support – as natural as it is, the incredible demand and vulnerability of this time can be challenging as well as full of opportunity to learn, to grow, to heal and to develop as a person.
- Understand that what we consider “death” is simply a transformation, a change in form, an unavoidable and universally shared part of life. Finding meaning and making sense, coming to terms and taking stock, reflecting on life and releasing into the inevitable, and grieving are all essential elements in this transition process.
- Besides playing beautiful music, consider playing audio-books and light hearted movies that are free from violence and jarring noises and scenes. Because people nearing transition are particularly prone to confusion, a violent scene in a book or movie can have highly traumatizing effect on the nervous system and mind, sometimes leading them to be unable to distinguish a scene from a book and their own life. This can create incredible discomfort, nightmares and terror. Staying away from particularly distressing current events and emotionally-charged news reports can be calming as well.
- Head massage, reflexology, acupuncture, music, meditation, cranio-sacral therapy and hand-holding are some of the modalities that can bring great ease to the mind.
3. Comfort – Emotional
- All of the above support emotional comfort.
- Allowing emotions to flow is one of the most important aspects of transitioning well. Whatever they are – welcome them with loving arms. Welcome the joy, welcome the sadness, welcome the fear, welcome the anger and allow it to move through. Honor the feelings as rich expressions of what it is to be human.
- Being overwhelmed and flooded by emotions, however, is not helpful and can often create great distress. This is where the above-mentioned modalities and counseling can greatly help.
- Consider herbal preparations such as RelaxMax, Ashwaghanda, and calming teas that have Poppy, Lemon Balm and Valerian to bring emotional equanimity. CBD may also be very helpful in some cases.
- Find joy and laugher, no matter what. Jokes, recollections of silly moments, funny animal videos/noises…however it comes, invite and amplify joyful moments. Nothing is more healing to the heart…besides love…which is a form of joy.
- Read books on fostering an open heart and compassion – you can read them together! Just the words can help bring tenderness and ease to the stresses of misunderstandings and misattunements that can happen so frequently in being with someone through their transition.
- Understand that there is no guilt or shame about “waiting for someone to die”. That feeling is natural – in fact, it is compassionate, because to be done with suffering and entrapment is actually freedom.
4. Comfort – Spiritual
- Regardless of spiritual or religious affiliation, the liminal space of end-of-life transitions is sacred and leaden in mystery. It can be utterly terrifying and feel meaningless. It can be just another day, although rarely so. And it can be a mystical portal that, no matter who someone is, can open them up to new dimensions and depths of being. Whether navigated consciously and intentionally or not, this time is rife with opportunity.
- If you don’t have a religious or spiritual practice or guidance, consider looking at this entire time as a ritual. A rite of passage. A sacred ceremony. There is something to open to here, for everyone involved.
- In Chinese medicine and philosophy, it is believed that humans have multiple souls. The Hun, or the ethereal soul, travels from body to body across lifetimes. There are specific acupuncture points on the body to support the transitioning Hun as it takes its acquired wisdom and lessons on to the next. The Po, or the Corporeal soul, is a soul that enters the body just for this lifetime and does not move on to the next. It accounts for more of the physical experience of being human. It is believed that an unreconciled Hun/Po imbalance brings great pain and suffering to those living as well as at transitional times of life. I have treated many patients to balance their Hun/Po with remarkable results such as easement and resolution of chronic pain (emotional and physical), easement of perpetual restlessness and feelings of dissatisfaction in life, and end-of-life feelings of regret.
5. Nutrition
- Nutritious food is important at all times. Inflammatory foods such as fried, greasy, oily, spicy, dairy, alcoholic, sugary and gluten-rich foods will create pain, emotional distress and difficulty healing in anyone. And, it’s so important to have the joy of a tasty treat! Balance is key – blended smoothies that contain vitamins and powdered superfoods can bring a sense of wellbeing even leading up to the final moments.
- Baby food is a great go-to for those having difficulty chewing or swallowing.
- Electrolytes are literally life-saving. Sometimes the appetite goes and someone who is laying in bed all day is either intentionally or naturally not wanting to really eat anymore. In this case, putting electrolytes into their water is essential. Electrolyte depletion and imbalance can be a very painful and distressing experience in the body.
- Hydration is key. If someone is unable to drink adequate amounts of water (and what is “adequate” is different for everyone), consider connecting an IV to keep someone hydrated and comfortable.
- If someone is very cold, or experiencing nausea, Ginger tea is great. If they’re hot and restless, try Peppermint tea instead.
6. Clean and Clear
- Hygiene is remarkably important. Cleaning and drying the body’s largest organ – the skin – is a big and essential task. Making sure the eyes and mouth are clear, brushing teeth, thoroughly cleaning the evacuation sites, keeping nails filed and hair brushed – all of these are essential basics that help not only to prevent infections, but to keep someone feeling dignified and fresh.
- Making sure evacuation – bowel and urinary – is happening regularly is a BIG deal. My favorite bowel mover is a product called ColonX – all natural and non-purgative, regular doses keep anyone regular. Suppositories and enemas may be necessary, some folks have colostomy bags and others require catheters. Keeping all the plumbing in working order is as essential to a human being as it is to a high-occupancy apartment building! Other common helpers are prune juice, aloe, flax seed and walnuts, and cranberry juice to keep the kidneys and urinary tract clear.
- Keeping the surrounding space clear is also beneficial to everyone’s sense of wellbeing. Not only that, cleaning and clearing nearby spaces prevents injury and infection.
- Be clean and clear in your communication. When the mind starts to become slow, foggy, prone to confusion – nuance and subtlety in expression is hard to follow. There can still be softness, sweetness, and exquisiteness in simple expression.
Having worked at nursing homes, sat at death beds and offered hospice care, Dr. Karina is a great resource. You can learn more about her work and explore working together, HERE.
